DHA Case No. MGE 221598 (Wis. Div. Hearings and Appeals Mar. 27, 2026) (DHS) ↓ Download PDF Medicaid applicants are required to verify all countable assets. In this case, the petitioner failed to verify a prepaid debit card and whether her home had been sold. Although this failure was apparently due to past financial abuse […] Read more

DHA Case No. FCP 221429 (Wis. Div. Hearings and Appeals Mar. 26, 2026) (DHS) ↓ Download PDF Community Waivers members in Group A have no cost share. In this case, the petitioner moved from Group A to Group B when she lost her eligibility for the Widow/Widower Group (a special status class of full-benefit Medicaid) […] Read more

DHA Case No. CWA 220447 (Wis. Div. Hearings and Appeals Mar. 25, 2026) (DHS) ↓ Download PDF IRIS participants are generally entitled to a fair hearing appeal of adverse actions, defined as a denial, reduction, termination or limitation of previously authorized services, a denial of requested services, or a determination of ineligibility. In this case, […] Read more

DHA Case No. FCP 221622 (Wis. Div. Hearings and Appeals Mar. 19, 2026) (DHS) ↓ Download PDF In the Family Care program, the services provided must reasonably and effectively address all long-term needs to assist the client to be as self-reliant and autonomous as possible, but it must also be cost-effective. In this case, the […] Read more

DHA Case No. MGE 220677 (Wis. Div. Hearings and Appeals Mar. 17, 2026) (DHS) ↓ Download PDF Enrollment in Family Care may be backdated if an unreasonable delay was caused by agency error. In this case, the petitioner applied for Medicaid, requested Community Waivers, and was financially eligible on July 15, 2025. But, due to […] Read more

DHA Case No. FCP 220337 (Wis. Div. Hearings and Appeals Mar. 17, 2026) (DHS) ↓ Download PDF Enrollment in Family Care may be backdated if an unreasonable delay was caused by agency error. In this Milwaukee County case, the ADRC took four months to complete a functional screen and another three months to complete enrollment. […] Read more

DHA Case No. CWA 220811 (Wis. Div. Hearings and Appeals Mar. 16, 2026) (DHS) ↓ Download PDF IRIS policy provides that a budget amendment (BA) may only be used for costs that exceed a recipient’s base budget and may not be transferred to a different service or service type. In this case, the agency reduced […] Read more

DHA Case No. CWA 220073 (Wis. Div. Hearings and Appeals Mar. 3, 2026) (DHS) (decision after rehearing) ↓ Download PDF IRIS participants must treat the people who are part of the program with respect, including having a safe space in the participant’s home for meetings. In this case, the agency sought disenrollment after a meeting […] Read more

DHA Case No. MRA 13/99632 (Wis. Div. Hearings and Appeals Feb. 3, 2009) (DHS) ↓ Download PDF An ALJ may increase the community spouse income allocation (CSIA) above the minimum monthly maintenance needs allowance (MMMNA) determined by the agency if the MMMNA is insufficient to meet the community spouse’s basic maintenance needs. In this case, […] Read more

DHA Case No. CWA 221689 (Wis. Div. Hearings and Appeals Apr. 28, 2026) (DHS) ↓ Download PDF An IRIS participant who receives Daily Living Skills Training services (now called Life Skills Training and Education services) must generally demonstrate skill development within a year, or longer if reasonably needed to acquire the skill. Also, as skills […] Read more

DHA Case No. CWA 221317 (Wis. Div. Hearings and Appeals Feb. 27, 2026) (DHS) ↓ Download PDF Every IRIS participant enrolled in the self-directed personal cares (SDPC) program must have a care plan signed annually by the participant’s SDPC nurse and physician. In this case, the petitioner’s SDPC nurse attempted to visit multiple times to […] Read more

DHA Case No. FCP 221117 (Wis. Div. Hearings and Appeals Feb. 23, 2026) (DHS) ↓ Download PDF Residential care services provided through Family Care MCOs may be authorized only when a member’s long-term care outcomes cannot be cost-effectively supported in the member’s home, or when a member’s health and safety cannot be adequately safe guarded […] Read more

DHA Case No. MGE 221661 (Wis. Div. Hearings and Appeals Feb. 20, 2026) (DHS) ↓ Download PDF The state must maintain Medicaid coverage while completing regularly scheduled renewals as long as the renewal is received before the end of the month the renewal is due. In this case, the petitioner was enrolled in Family Care […] Read more

DHA Case No. MKB 221000 (Wis. Div. Hearings and Appeals Feb. 17, 2026) (DHS) ↓ Download PDF To qualify as disabled for the Katie Beckett program, a child must have an impairment that causes “marked and severe functional limitations.” In this case, the petitioner had autism and ADHD, was in an age-appropriate grade in school, […] Read more